目的 分析不同时机使用枸橼酸咖啡因防治极低出生体重儿呼吸暂停的临床疗效及不良反应。方法 以湖州市妇幼保健院2014年5月-2017年2月收治的126例极低出生体重儿为试验对象:其中65例出生后即使用枸橼酸咖啡因的患儿为早期治疗组,均于生后2 h内完成用药[首次用药完成时间为生后(1.2±0.4) h],首剂20 mg/kg,24 h后给予5 mg/kg,每24 h 1次,静脉泵入;61例出现呼吸暂停后再使用枸橼酸咖啡因的患儿为常规治疗组,常规治疗组[首次用药完成时间为生后(30.8±20.5) h]用药剂量及方法同早期治疗组。比较两组患儿临床疗效及不良反应。结果 1)两组患儿用药24 h后呼吸暂停发生率、枸橼酸咖啡因干预时间、氧疗时间、无创呼吸机辅助通气时间、气管插管机械通气时间、达到全肠道喂养的时间方面比较,早期治疗组优于常规治疗组,差异均有统计学意义(P<0.05);两组患儿接受无创呼吸机辅助通气率、气管插管机械通气率差异均无统计学意义(P>0.05)。2)两组患儿脑室内出血、早产儿视网膜病、支气管肺发育不良的发生率,早期治疗组低于常规治疗组,差异有统计学意义(P<0.05);两组患儿的坏死性小肠结肠炎的发生率、病死率方面差异无统计学意义(P>0.05)。3)不良反应事件比较:两组患儿电解质紊乱的发生率早期治疗组多于常规治疗组,差异有统计学意义(P<0.05);其他不良反应发生率差异无统计学意义(P>0.05)。结论 早期治疗组在防治早产儿呼吸暂停疗效及近期预后均优于常规治疗组,不良反应无明显增加。

Objective To compare the clinical efficacy and adverse effects of caffeine citrate in apnea prevention and treatment of very low birth weight (VLBW) infants at different starting time. Methods Totally 126 VLBW infants born at Huzhou Maternity and Child Health Care hospital from May,2014 to February,2017 were analyzed.65 VLBW infants first given caffeine citrate within two hours after the birth were early treatment group[The first dose were given at (1.2±0.4) hours after the birth] and 61 VLBW infants who were given caffeine citrate after appearing apnea were conventional treatment group[The first dose were given at (30.8±20.5) hours after the birth].The first dose of 20 mg/kg was given by intravenous infusion,a dose of 5 mg/kg after 24 hours,and once every 24 hours.The clinical efficacy and adverse effects of two groups were compared. Results 1)The incidence of AOP after 24 hours treatment,intervention duration of caffeine citrate,duration of oxygen therapy,duration of noninvasive ventilation,duration of tracheal intubation mechanical ventilation and time to reaching full milk feeding in early treatment group were better than those in conventional treatment group,and the differences were statistically significant (P<0.05).The differences of noninvasive ventilation rate and tracheal intubation mechanical ventilation rate in two groups were not statistically significant (P>0.05).2)The incidence rates of ventricular hemorrhage,retinopathy of prematurity,bronchial and pulmonary dysplasia in early treatment group were lower than those in the conventional treatment group,and the differences were statistically significant (P<0.05);The incidence of necrotizing enterocolitis and mortality were not significantly different in two groups (P>0.05).3)The incidence of electrolyte disorder in early treatment group was higher than conventional treatment group,the difference was statistically significant (P<0.05).There was no significant difference on the incidence of other adverse reactions in two groups (P>0.05). Conclusion The efficacy and prognosis of early use of caffeine citrate maybe better than that regular given after apnea for apnea prevention and treatment in VLBW infants,and the adverse effects do not increase obviously.